Build Your Own Eye: A Method for Teaching Ocular Anatomy and Pathophysiology

Audience Residents and medical students Introduction The eye is a critical, but often neglected, part of medical learning. This team-based learning (TBL) module was developed for emergency medicine residents and medical students; however, is applicable to any learner who should know basic eye anatomy and pathology. Emergency medicine teams, primary care providers, and ophthalmologists are most likely to encounter ocular emergencies.1–3 These emergencies are uncommon but quite dire when they occur and can result in permanent disability and life-changing morbidity.2, 4 It is critical that medical practitioners who are exposed to these types of emergencies are well prepared to evaluate and treat them. To fully understand how pathology affects the eye, it is critical that learners understand the anatomy and physiology of the eye.5, 6 Many diagnoses are associated with specific parts of ocular anatomy;5, 6 therefore, teaching pathology in an anatomy-based lesson will help learners understand the physiology. This lesson teaches learners about physiology and pathology in a systemic, anatomically oriented way. Educational Objectives By the end of this session the participant will be able to: Describe basic anatomy of the eye. Build a basic model of the eye. Identify which diseases are associated with which parts of the eye. Identify the pathophysiology behind diseases of the eye. Name correct treatment for each disease. Educational Methods The “build your own eye” lesson was taught as a classic team-based learning (cTBL) exercise. The modality of TBL with hands-on construction of an eye allow for social learning, competition and spatial learning related to anatomy. The creation of an eye allows residents to fully understand ocular anatomy which is not as evident when a two-dimensional paper image is used. Some learners need tactical stimuli for better understanding. This aspect of the exercise was focused on using alternative modalities to enhance spatial learning. These concepts are reinforced by the GRAT and IRAT portions of the exercise which tend to multiple choice learners. The fill-in the-blank aspect of the exercise requires recall and research to match the three-dimensional eye parts with pathology. Research Methods Learners were given the opportunity to complete an anonymous survey. Verbal feedback was also obtained from learners during the lesson. The survey asked learners questions about the effectiveness and value of the exercise, whether the content was applicable to work in the emergency department, whether this exercise should be kept as a part of the curriculum, and whether there was any practice-changing information. Learners enjoyed the competitive aspects of the exercise and also noted that they felt much more comfortable with ocular anatomy and pathology after the lesson. Results Learners felt that the ocular team-based learning module was effective in teaching more about the eye in an atypical way. Some learners felt that an explanation in advance of the eye building aspects of the project may have been helpful so they could have brought supplies from home. Other learners felt that they would not have brought supplies from home; thus no explanation was necessary. Discussion Learners seemed to enjoy the experience. The competitive aspects of the TBL, where the eye models were judged for accuracy, creativity, and appearance as well as the correct answers on the worksheet, seemed to enhance learner enjoyment and engagement. Learners felt that enough time was provided for the exercise. While some learners would have preferred an explanation in advance of the project in order to bring supplies from home, others felt that this was not necessary. Educators should determine what would be preferred by their particular learning group for future implementations. Topics Eye lid, tear duct, cornea, conjunctiva, pupil, iris, lens, anterior chamber, vitreous body, posterior chamber, retina, macula, choroid, optic disc, optic nerve, retinal artery, retinal vein, blepharitis, hordeolum, chalazion, canaliculus, dacryocystitis, corneal abrasion, corneal ulcer, ultraviolet keratitis, herpes keratitis, astigmatism, bacterial conjunctivitis, viral conjunctivitis, episcleritis, globe rupture, iritis, uveitis, anterior uveitis, posterior uveitis, hypopyon, hyphema, acute angle closure glaucoma, congenital pupillary deformity, coloboma, globe rupture, nevus, essential iris atrophy, cataracts, presbyopia, myopia, hyperopia, traumatic iritis, iridocyclitis, ciliary body melanoma, vitreous degeneration, vitreous hemorrhage, endophthalmitis, macular degeneration, retinal detachment, choroid nevus, choroid detachment, papilledema, optic nerve glioma, optic nerve meningioma, anterior ischemic optic neuropathy, retinal artery occlusion, retinal vein occlusion.


Results and tips for successful implementation:
This exercise was presented during residency conference for a group of approximately 24 emergency medicine residents and medical students. It is best implemented in a group setting with between one and six learners per group and two to six groups. We did not obtain a direct assessment of learner acquisition of knowledge; however, we were able to informally assess learner knowledge by responses throughout the session as well as by the iRAT and gRAT. Implementation went smoothly, and we did not make further modifications to the didactic session.
The following items should be purchased prior to the session: The instructor will also need to print (or create an online quiz) one copy of the iRAT per learner and one copy of the gRAT and GAE per 4-6 learners.
The learners should be assigned the LRC (listed below) at least three days prior to the didactic session. Upon entry to the didactic session, learners are given the iRAT. Learners are given 5-10 minutes to complete the iRAT and then another 5-10 minutes for the gRAT after splitting into small groups of 4-6 members. The materials were provided for the learners in our implementation; however, the instructor could also suggest students bring their own supplies if learners would like specific materials. Cost depends on regional differences, existing supplies in the residency, and whether learners bring their own supplies. We spent approximately $30.00 for all of the supplies.
For the GAE, learners "build" an eye using the materials provided. They are asked to include a list of anatomical structures that must be present on the model eye (See Group Application Exercise: Eye Anatomy Worksheet). The construction phase is open-resource or "open book." An instructor should advise learners that their GAE will be "scored." The students must also name at least one disease/pathologic finding with symptoms and treatment associated with each structure (See Group Application Exercise: Eye Anatomy Worksheet). Learners lose one point for any structure for which they are unable to name a disease. Learners are given extra points for each additional disease named. The instructor can award ten additional points for best eye model, as judged by a panel of faculty present during the exercise. At the end of the implementation, one winning team is selected to "win" the exercise. (Learners can be given plastic or paper medals). After the exercise, the instructor performs a post-GAE review.
This method of implementation was chosen because many ocular pathologies are associated with specific structures. Structure-based learning may allow students to comprehend the anatomy and physiology behind the disease. In this way, learners are better able to identify which pathologies are present on imaging tests and by physical exam. This may result in more rapid identification of diseases when they present in the clinic or emergency department. birthday. He thinks he has had "a few" drinks this evening. His friends tell you that he got into an "epic" bar fight when someone took his "birthday chair." He is not cooperative with examination but you note that there is a laceration extending from the right mid upper eyelid medially to the nose. He has notable conjunctival injection bilaterally. A fluorescein stain is negative and he has normal ocular pressures. What is the next step in management? a. Tell him you are going to give his "birthday gurney" to another patient and send him back to the bar after giving him antibiotics. b. Repair the laceration after a thorough eye wash. c. Call ophthalmology to repair the laceration. d. Sedate him and repair the eyelid.